Objective: This network meta-analysis evaluated the efficacy of different prehabilitation modalities for patients undergoing digestive system cancer surgery.

Methods: A systematic search of PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science was conducted from inception to March 1, 2025. Randomized controlled trials assessing exercise-based (EX), nutrition-based (NU), or multimodal (Mul) prehabilitation were included. Primary clinical outcomes were length of hospital stay (LOS) and postoperative complications, while functional outcomes included 6-minute walking distance (6MWD), anxiety, depression, and quality of life (QoL). Pairwise meta-analyses estimated mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CIs). A network meta-analysis was performed to rank interventions using surface under the cumulative ranking (SUCRA) probabilities.

Results: Twenty-six RCTs involving 2042 patients were included. Pairwise meta-analyses showed that prehabilitation significantly reduced LOS (MD = -1.12, 95%CI = -1.99, -0.26) and postoperative complications (OR = 0.71, 95%CI = 0.59, 0.86), while improving 6MWD (MD = 35.59, 95%CI = 20.47, 50.72) and QoL (MD = 5.96, 95%CI = 2.00, 9.92). Subgroup analyses indicated that gastric cancer patients benefited more in terms of complication reduction. The network meta-analysis ranked EX as the most effective for reducing postoperative complications (SUCRA = 88.9%), followed by Mul (SUCRA = 74.0%). For functional outcomes, EX ranked highest for postoperative 6MWD improvement (SUCRA = 81.0%), while Mul was superior in improving presurgery 6MWD (SUCRA = 74.9%), QoL (SUCRA = 99.2%), and depressive symptoms (SUCRA = 87.9%).

Conclusion: Prehabilitation, particularly EX and Mul, effectively reduces postoperative complications and enhances functional recovery in digestive system cancer surgery. Clinicians should consider patient-specific factors when selecting prehabilitation strategies. Future research should standardize intervention protocols and outcome measures to optimize perioperative care.

Keywords: Complications; Digestive System Neoplasms; Exercise Therapy; Network meta-analysis; Prehabilitation; Randomized controlled trials.

Copyright © 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.

目的：这项网络荟萃分析评估了不同术前康复方案对消化系统癌症手术患者的疗效。

方法：从建库至2025年3月1日，系统检索了PubMed、Medline、Embase、Cochrane中央对照试验注册库和Web of Science。纳入随机对照试验，评估基于运动（EX）、营养（NU）或综合模式（Mul）的术前康复方案的效果。主要临床结局指标包括住院时间（LOS）和术后并发症，功能性结局包括6分钟步行距离（6MWD）、焦虑、抑郁以及生活质量（QoL）。成对荟萃分析估计平均差（MD）或比值比（OR），并计算95%置信区间（CI）。使用表面下累计排名概率（SUCRA）进行网络荟萃分析，以排列表现优异的干预措施。

结果：共纳入26项随机对照试验，涉及2042名患者。成对荟萃分析显示，术前康复方案显著缩短了住院时间（MD = -1.12，95%CI = -1.99, -0.26）和减少了术后并发症（OR = 0.71，95%CI = 0.59, 0.86），同时改善了6分钟步行距离（MD = 35.59，95%CI = 20.47, 50.72）和生活质量（MD = 5.96，95%CI = 2.00, 9.92）。亚组分析表明胃癌患者在减少并发症方面受益更多。网络荟萃分析显示，EX在减少术后并发症方面的效果最佳（SUCRA = 88.9%），其次是Mul（SUCRA = 74.0%）。对于功能性结局，EX在改善术后6分钟步行距离（SUCRA = 81.0%）方面排名最高，而Mul则在提高术前6分钟步行距离（SUCRA = 74.9%）、生活质量（SUCRA = 99.2%）和缓解抑郁症状（SUCRA = 87.9%）方面更优。

结论：术前康复，特别是基于运动的EX和综合模式Mul，在减少消化系统癌症手术术后并发症和促进功能恢复方面效果显著。临床医生在选择术前康复策略时应考虑患者的特定因素。未来的研究应该标准化干预方案和结局测量方法以优化围手术期护理。

关键词：并发症；消化系统肿瘤；运动疗法；网络荟萃分析；术前康复；随机对照试验。

版权所有 © 2025 Alimentary Tract Surgery Society。由Elsevier Inc.出版。保留所有权利。